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Posts Tagged ‘pediatrics’

What Every Pediatrician Should Know About Health Care Reform

August 15, 2012 1 comment

Below is what every Pediatrician should know about health care reform.  

The provisions listed below will have a direct impact on pediatric care and pediatricians need to take the time to familiarize themselves with the new regulations.
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New Pediatric Regulations

Section 1001 Subsection 2713 – Coverage of Preventive Health Care
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for-evidence-based items or services that have in effect a rating of `A’ or `B’ in the current recommendations of the United States Preventive Services Task Force; immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.

Section 1001 Subsection 2714 – Extension of Child Coverage
A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age.

Section 1201 Subsection 2704 – Prohibition of Preexisting Conditions
A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.

Section 2004 – Medicaid Coverage for Former Foster Children
Medicaid coverage for former foster children who were in foster care under the responsibility of a State for more than 6 months.

Section 2302 – Concurrent Care for Children
A voluntary election to have payment made for hospice care for a child (as defined by the State) shall not constitute a waiver of any rights of the child to be provided with, or to have payment made under this title for, services that are related to the treatment of the child’s condition for which a diagnosis of terminal illness has been made.

Section 4204 – Immunizations
Funds received under a grant under this subsection shall be used to implement interventions that are recommended by the Task Force on Community Preventive Services (as established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention) or other evidence-based interventions, including–providing immunization reminders or recalls for target populations of clients, patients, and consumers;educating targeted populations and health care providers concerning immunizations in combination with one or more other interventions; reducing out-of-pocket costs for families for vaccines and their administration; carrying out immunization-promoting strategies for participants or clients of public programs, including assessments of immunization status, referrals to health care providers, education, provision of on-site immunizations, or incentives for immunization; providing for home visits that promote immunization through education, assessments of need, referrals, provision of immunizations, or other services; providing reminders or recalls for immunization providers;conducting assessments of, and providing feedback to, immunization providers; any combination of one or more interventions described in this paragraph; or immunization information systems to allow all States to have electronic databases for immunization records.

Section 5203 Subsection 775 – Pediatric Loan Forgiveness Program
The Secretary shall establish and carry out a pediatric specialty loan repayment program under which the eligible individual agrees to be employed full-time for a specified period (which shall not be less than 2 years) in providing pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent mental and behavioral health care, including substance abuse prevention and treatment services.

Section 5501 – Expanded Access to Primary Care
Expanded access to primary care. In the case of primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care practitioner, in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 10 percent of the payment amount for the service under this part.
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Every Pediatrician  needs to make sure that they take the time to familiarize themselves with the above regulations. To learn more, please click HERE

What Every Medical Practice Manager Should Know About Health Care Reform

August 6, 2012 Leave a comment

Below is what every Medical Practice Manager should know about health care reform.

The provisions listed below will have a direct impact on medical practice management and practice managers need to take the time to familiarize themselves with the new regulations.

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Section 1001 Subsection 2712- Prohibition on Recissions
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved.

Section 1001 Subsection 2713 – Coverage of Preventive Health Care  

A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for-evidence-based items or services that have in effect a rating of `A’ or `B’ in the current recommendations of the United States Preventive Services Task Force; immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. with respect to women, such additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration.

Section 1001 Subsection 2714 – Extension of Dependent Coverage
A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age.

Section 1201 Subsection 2704 – Prohibition of Preexisting Conditions
A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.

Section 1421 – Tax Credit for Employee Health Insurance Expenses of Small Businesses
An eligible small employer, the small employer health insurance credit amount is 50 percent (35 percent in the case of a tax-exempt eligible small business).

Section. 3111 – Payment for Bone Density Tests
For dual-energy x-ray absorptiometry services (identified in 2006 by HCPCS codes 76075 and 76077 (and any succeeding codes)) furnished during 2010 and 2011, instead of the payment amount that would otherwise be determined under this section for such years, the payment amount shall be equal to 70 percent of the product.

 
Section 3134 – Misvalued Codes Under Physician Fee Schedule

For purposes of identifying potentially misvalued services pursuant to clause (i)(I), the Secretary shall examine (as the Secretary determines to be appropriate) codes (and families of codes as appropriate) for which there has been the fastest growth; codes (and families of codes as appropriate) that have experienced substantial changes in practice expenses; codes for new technologies or services within an appropriate period (such as 3 years) after the relative values are initially established for such codes; multiple codes that are frequently billed in conjunction with furnishing a single service; codes with low relative values, particularly those that are often billed multiple times for a single treatment; codes which have not been subject to review since the implementation of the RBRVS (the so-called `Harvard-valued codes’); and such other codes determined to be appropriate by the Secretary.

Section  4104 – Elimination of Co-Pay

Elimination of coinsurance (co-pay) on preventive services (ie. physical exams). Elimination of coinsurance (co-pays) in outpatient hospital settings.

Section  4108 – Incentives for Prevention of Chronic Diseases

Incentives for prevention of chronic diseases. A program described in this paragraph is a comprehensive, evidence-based, widely available, and easily accessible program, proposed by the State and approved by the Secretary, that is designed and uniquely suited to address the needs of Medicaid beneficiaries and has demonstrated success in helping individuals achieve one or more of the following: ceasing use of tobacco products, controlling or reducing their weight, lowering their cholesterol, lowering their blood pressure, avoiding the onset of diabetes or, in the case of a diabetic, improving the management of that condition.

Section 4204 – Immunizations
Funds received under a grant under this subsection shall be used to implement interventions that are recommended by the Task Force on Community Preventive Services (as established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention) or other evidence-based interventions, including–providing immunization reminders or recalls for target populations of clients, patients, and consumers;educating targeted populations and health care providers concerning immunizations in combination with one or more other interventions; reducing out-of-pocket costs for families for vaccines and their administration; carrying out immunization-promoting strategies for participants or clients of public programs, including assessments of immunization status, referrals to health care providers, education, provision of on-site immunizations, or incentives for immunization; providing for home visits that promote immunization through education, assessments of need, referrals, provision of immunizations, or other services; providing reminders or recalls for immunization providers;conducting assessments of, and providing feedback to, immunization providers; any combination of one or more interventions described in this paragraph; or immunization information systems to allow all States to have electronic databases for immunization records.
 
Section 5202 –  Nursing Student Loan Repayment

The Secretary shall establish and carry out a pediatric specialty loan repayment program under which the eligible individual agrees to be employed full-time for a specified period (which shall not be less than 2 years) in providing pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent mental and behavioral health care, including substance abuse prevention and treatment services.

 
Section 5301 – Financial Assistance for Students Going Into Primary Care
To provide need-based financial assistance in the form of traineeships and fellowships to medical students, interns, residents, practicing physicians, or other medical personnel, who are participants in any such program, and who plan to specialize or work in the practice of the fields of family medicine, general internal medicine, or general pediatrics training programs.

Section 5501 – Incentive Payments for Primary Care Physicians
Incentive payments for primary care physicians. In the case of primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care practitioner, in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 10 percent of the payment amount for the service under this part.
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Every Medical Practice Manager must take time to read and understand the above regulations. For more information, click HERE